1) I Travelled in the Class/Mode Mentioned Above

From. Date:_____- 12 - 2017
Name: ______
Address:______
______
______/ To
The Convener
Kishore Vaigyanik Protsahan Yojana
Indian Institute of Science
BANGALORE 560 012
[tick] / [tick] / [tick]
KVPY Fellow: / IISER-Pune: / IIT-Madras: / IIT, Bombay
IISER-TVM: / IISER, Tirupati / IIT, Hyderabad / CBSC, Mumbai
INSPIRE Scholar: / Pune University: / University of Hyd: / Others
KVPY Registration No:
Purpose of Journey: For participate in the National Science (VIJYOSHI) Camp – 2017 at IISc, Bangalore during 8th – 10th December 2017
Details / From (station) / Date / To
(Station) / Date / Mode of Travel / Amount Rs.
(Fare) / Remarks *
(For Office Use)
Onward Journey / Bangalore
Return Journey / Bangalore
Total Amount:
Amount in words: (Rupees______...... Only)

Certified that

1) I travelled in the class/mode mentioned above.

2) I have not drawn T.A. for the above journey from any other source.

3) Enclosed copy of the Tickets (Air / Train / Bus).

Date: Signature of the Participant

Name of the account holder:
Account Number:
Name of the Bank and Place:
IFSC Code Number:

2. Submit the Filled form at the Registration Desk at Bangalore on the day of your arrival along with, (a) Original onward journey ticket (Train or Bus) or Original Boarding Pass (If travelled by Flight). (b) Copy of the return journey tickets (Train or Bus or Flight). Without above said documents, reimbursement will not be made.